Our Repair Patient Today From Central America

Our patient today comes to us from Central America. Several years ago he had seborrheic dermatitis and as a result his hair became noticeably thinner. He decided to undergo hair restoration surgery approximately one year ago. Our patient told me that he didn't do any research and settled on a local doctor in Central America. The result is obvious... a widened strip scar, 1,2,3 and 4-hair grafts placed right on the hairline at a low density. Another issue with his result is "tenting", or a raised appearance that looks like follicular units growing from small hypopigmented bumps. On the positive side, our patient's hair loss stopped a short time after he got past the seborrheic dermatitis. He began taking Propecia to help with the seborrheic dermatitis related hair loss and he now, even before repair surgery has (native hair) excellent density on top. A scar like this generally takes two or more passes. Our patient loves to surf and he told me that the current state of his strip scar is keeping him off the beach and he avoids getting his head wet in public.

Optimally, this is three procedures. One procedure to remove the prior grafts that are angled incorrectly, have far too many hairs in them, and as bad as it gets in this current day and age. We rarely see recent work like this, but we do still see it. The second procedure is to build a new, aesthetic hairline. The third is to repair the saw tooth scar. The patient wanted to accomplish all three procedures, as best as possible, in one procedure. That's a tall order. It is easy to do anyone of them in one day. It is a logistical problem to accomplish all three in one day.

The optimal way to approach this case is to do either the graft removal in one day, wait at least one month, and then build a new hair line OR build a new hair line, wait one year, and then take out the unnatural grafts. Anytime you try to remove grafts and build a new hairline at the same time, you compromise the other procedure. Fortunately, the grafts were widely spaced and many were well below the future location for the hairline. Thus, we were able to accomplish a new hair line and take out many of the unnatural grafts. We still have work to do later on, but much of the job is now done.

The complicating factor was the appearance of scar tissue in the recipient area. This suggests that a higher density was grafted and much of it did not grow. We will have to wait to see how this impacts the future result.